Lee R. Logan, D.D.S., Prof. Corp.
Dentist in Northridge, CA. Organization (NPI-2).
NPI number1003869769
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1003869769
- Entity type
- Organization (NPI-2)
- Legal business name
- Lee R. Logan, D.D.S., Prof. Corp.
- Organization subpart
- No
- Enumeration date
- May 17, 2006
- Last updated
- Aug 22, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 13848 | CA | Yes |
Practice location
18250 Roscoe BlvdSuite #315
Northridge, CA 91325-4226
Phone 818-885-8650 · Fax 818-885-7169
Mailing address
18250 Roscoe BlvdSuite #315
Northridge, CA 91325-4226
Phone 818-885-8650 · Fax 818-885-7169
Authorized official
Lee Robert Logan
President
8188858650
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